Effects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty

Zhang,Peng; Feng,Feifei; Cai,Qiqing; Yao,Weitao; Gao,Songtao; Wang,Jiaqiang; Wang,Xin

doi:10.3892/etm.2014.1744

Effects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty

Authors:
- Peng Zhang
- Feifei Feng
- Qiqing Cai
- Weitao Yao
- Songtao Gao
- Jiaqiang Wang
- Xin Wang
View Affiliations

Affiliations: Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, P.R. China, Department of Toxicology, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
Published online on: May 28, 2014 https://doi.org/10.3892/etm.2014.1744
Pages: 567-572

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

In this study, the effects of surgical removal of malignant metaphyseal bone tumors with epiphysis preservation and knee arthroplasty were analyzed. A total of 15 patients with malignant metaphyseal bone tumors were investigated. Six of these patients underwent epiphyseal preservation surgery with preoperative physeal distraction, termed the physeal distraction (PD) group. Nine patients underwent resection of the knee joint, combined with metal prosthesis transfer, termed the knee arthroplasty (KA) group. Tumor control, limb length discrepancy, range of movement (ROM) of the knee and functional outcome of lower limb [Musculoskeletal Tumor Society (MSTS) score and the Toronto extremity salvage score (TESS)] were assessed for these two groups. All 15 patients were followed‑up after the surgery. One patient in the PD group was found to have lung tumor metastasis; however, no local tumor recurrence was found. In the KA group, local tumor recurrence was found in one patient, and lung metastases were observed in two cases postoperatively. The limb length discrepancy in patients of the PD group was 2.58±0.27 cm, which was significantly less compared with that in patients in the KA group (4.01±0.13 cm; P<0.05). In addition, the lower limb knee ROM in patients in the PD group was 127.70±14.63˚, which was increased compared to that in patients in the KA group (105.70±15.48˚; P<0.05). The mean MSTS score was 86.67% with a mean TESS of 82.33% in patients from the PD group, which showed no significant difference compared with the respective scores for patients in the KA group (P>0.05). Therefore, epiphyseal sparing limb‑saving surgeries should be considered for the treatment of malignant metaphyseal bone tumors in children, when certain indications are satisfied.

View Figures

View References

1	Ottaviani G and Jaffe N: The epidemiology of osteosarcoma. Cancer Treat Res. 152:3–13. 2009. View Article : Google Scholar
2	Ries LAG, Melbert D and Krapcho M: SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute; 2006, http://seer.cancer.gov/csr/1975_2004/uri. Accessed September 30, 2013
3	Gurney JG, Swensen AR and Bulterys M: Malignant bone tumors. Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975–1995 Bethesda, MD: National Cancer Institute; 1999, http://seer.cancer.gov/publications/childhood/bone.pdfuri. Accessed September 30, 2013
4	Betz M, Dumont CE, Fuchs B and Exner GU: Physeal distraction for joint preservation in malignant metaphyseal bone tumors in children. Clin Orthop Relat Res. 470:1749–1754. 2012. View Article : Google Scholar : PubMed/NCBI
5	Abudu A, Grimer R, Tillman R and Carter S: The use of prostheses in skeletally immature patients. Orthop Clin North Am. 37:75–84. 2006. View Article : Google Scholar : PubMed/NCBI
6	Campanacci L, Manfrini M, Colangeli M, Ali N and Mercuri M: Long-term results in children with massive bone osteoarticular allografts of the knee for high-grade osteosarcoma. J Pediatr Orthop. 30:919–927. 2010. View Article : Google Scholar : PubMed/NCBI
7	Muscolo DL, Ayerza MA, Aponte-Tinao LA and Ranalletta M: Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am. 87(1 Suppl 2): 226–236. 2005.
8	Muscolo DL, Ayerza MA, Aponte-Tinao LA and Ranalletta M: Use of distal femoral osteoarticular allografts in limb salvage surgery. Surgical technique. J Bone Joint Surg Am. 88(1 Suppl 2): 305–321. 2006.PubMed/NCBI
9	Cañadell J, Forriol F and Cara JA: Removal of metaphyseal bone tumours with preservation of the epiphysis. Physeal distraction before excision. J Bone Joint Surg Br. 76:127–132. 1994.PubMed/NCBI
10	Weitao Y, Qiqing C, Songtao G and Jiaqiang W: Epiphysis preserving operations for the treatment of lower limb malignant bone tumors. Eur J Surg Oncol. 38:1165–1170. 2012. View Article : Google Scholar : PubMed/NCBI
11	El-Gammal TA, El-Sayed A, Kotb MM, Saleh WR and Ragheb YF: Knee joint reconstruction after hemiarticular resection using pedicled patella and vascularized fibular graft. Microsurgery. 30:603–607. 2010. View Article : Google Scholar : PubMed/NCBI
12	D‘Adamo DR: Appraising the current role of chemotherapy for the treatment of sarcoma. Semin Oncol. 38(Suppl 3): S19–S29. 2011.PubMed/NCBI
13	Enneking WF, Dunham W, Gebhardt MC, Malawar M and Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 241–246. 1993.
14	Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A and Bell RS: Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 5:508–516. 1996. View Article : Google Scholar : PubMed/NCBI
15	El Mesbahi O, Arifi S, Benbrahim Z, et al: A rare case of locally advanced fibrosarcoma of diaphysal humerus managed successfully with limb-sparing procedures after neoadjuvant chemotherapy. World J Surg Oncol. 8:772010.PubMed/NCBI
16	San-Julian M, Aquerreta JD, Benito A and Cañadell J: Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop. 19:543–548. 1999. View Article : Google Scholar : PubMed/NCBI
17	Bou Sleiman H, Ritacco LE, Aponte-Tinao L, Muscolo DL, Nolte LP and Reyes M: Allograft selection for transepiphyseal tumor resection around the knee using three-dimensional surface registration. Ann Biomed Eng. 39:1720–1727. 2011.PubMed/NCBI
18	Langlois V and Laville JM: Physeal distraction for limb length discrepancy and angular deformity. Rev Chir Orthop Reparatrice Appar Mot. 91:199–207. 2005.(In French).
19	De Bastiani G, Aldegheri R, Renzi Brivio L and Trivella G: Limb lengthening by distraction of the epiphyseal plate. A comparison of two techniques in the rabbit. J Bone Joint Surg Br. 68:545–549. 1986.PubMed/NCBI
20	Pereira BP, Cavanagh SP and Pho RW: Longitudinal growth rate following slow physeal distraction. The proximal tibial growth plate studied in rabbits. Acta Orthop Scand. 68:262–268. 1997. View Article : Google Scholar : PubMed/NCBI
21	Fang B, Yi C, Zhang H, et al: Combined epiphyseal preservation and autograft bone transfer in treatment of children osteosarcoma. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 27:45–49. 2013.(In Chinese).
22	Aksnes LH, Bauer HC, Jebsen NL, et al: Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br. 90:786–794. 2008. View Article : Google Scholar : PubMed/NCBI
23	Niimi R, Matsumine A, Hamaguchi T, Nakamura T, Uchida A and Sudo A: Prosthetic limb salvage surgery for bone and soft tissue tumors around the knee. Oncol Rep. 28:1984–1990. 2012.PubMed/NCBI